深低温间断停循环下肺动脉血栓内膜剥脱术

目的 探讨深低温间断停循环下肺动脉血栓内膜剥脱术治疗慢性肺动脉栓塞的临床效果。方法6例患者均在深低温分次停循环下经主肺动脉及左、右肺动脉切开行肺动脉血栓内膜剥脱术,手术清除段肺动脉开口以上视野可及范围内全部血栓内膜。结果 1例因术后急性灌注性肺水肿死亡,5例术后存活。肺动脉收缩压由术前的88～110 mmHg（1 mmHg=0.133kPa）下降至42～52 mmHg,同位素扫描肺血流灌注明显改善,肺动脉栓塞症状消失,心功能恢复至1级。结论 深低温间断停循环下肺动脉血栓内膜剥脱术是治疗慢性肺动脉栓塞的手术有效方法。     

慢性肺动脉栓塞的外科治疗

目的探讨慢性肺动脉栓塞的手术适应证及手术治疗效果。方法选择6例患者均在深低温分次停循环下经主肺动脉及左、右肺动脉切开行肺动脉血栓内膜剥脱术,手术清除段肺动脉开口以上视野可及范围内全部血栓内膜。结果1例因术后急性灌注性肺水肿死亡,5例术后存活。肺动脉收缩压由术前的88～110mmHg(1mmHg=0.133kpa)下降至42～52mmHg,同位素扫描肺血流灌注明显改善,肺动脉栓塞症状消失,心功能恢复至Ⅰ级。结论肺动脉血栓内膜剥脱术是安全、有效的治疗慢性肺动脉栓塞的手术方法。     

肺动脉血栓内膜剥脱术治疗慢性栓塞性肺动脉高压

目的报告肺动脉血栓内膜剥脱术治疗慢性栓塞性肺动脉高压的经验。方法回顾性总结了连续8例肺动脉血栓内膜剥脱术的手术要点、围术期处理以及近中期结果。结果8例均存活。肺动脉收缩压由术前的(101±24)mmHg降至术后的(39±15)mmHg、动脉血氧分压由(59±11)mmHg升至(92±7)mmHg。动脉血氧饱和度由(0.89±0.06)升至(0.98±0.01),均有显著改善。随访显示患者心功能为纽约心功能协会分级标准(NYHA)Ⅰ级(3例)或NYHAⅡ级(5例),生活质量明显改善。结论肺动脉血栓内膜剥脱术是治疗慢性栓塞性肺动脉高压的有效手段。     

慢性血栓栓塞性肺动脉高压的外科治疗

慢性血栓栓塞性肺动脉高压是一种自然预后极差的疾病,疾病早期容易误诊或漏诊.目前肺动脉血栓内膜剥脱术是慢性血栓栓塞性肺动脉高压患者的首选治疗方案,该手术效果明显,术后早期可明显降低肺动脉压力和肺血管阻力,改善血流动力学和患者生活质量.术前评估患者是否已存在严重的继发性肺小血管病变至关重要.术中建立正确的内膜剥离层面和完整的剥离血栓及机化内膜是外科技术的关键.     

书讯

<正>由首都医科大学附属北京安贞医院心脏外科中心,甘辉立教授主编的《肺动脉栓塞学》一书,已由人民军医出版社出版,其ISBN 978-7-5091-8006-8,有感兴趣者可在各大书店订购。全书原价为98元人民币。该书为中文著作,全书310页,附图60余帧,为有关急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压内科治疗及外科治疗的专著。急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压是严重威胁健康的疾病,死亡率和病残率都很高。抗凝治疗和溶栓治疗、肺动脉取栓术和肺动脉血栓内膜剥脱术治疗,分别是治疗急性肺动脉栓塞和慢性血栓栓塞性肺动脉高压的有效治疗方法,可     

球囊肺动脉成形术治疗肺动脉血栓内膜剥脱术后残余/复发肺动脉高压的疗效和安全性研究

目的:对球囊肺动脉成形术(BPA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)患者肺动脉血栓内膜剥脱术(PEA)术后残余/复发肺动脉高压的有效性和安全性进行评估。方法:本研究为单中心病例对照研究。采用非随机抽样的方法纳入2004年11月至2021年12月于首都医科大学附属北京朝阳医院行PEA的CTEPH患者76例,其中发...     

《中国肺动脉高压诊断与治疗指南(2021版)》解读：慢性血栓栓塞性肺动脉高压

慢性血栓栓塞性肺动脉高压(CTEPH)是一种急性肺血栓栓塞症的远期并发症。2021年1月,《中国肺动脉高压诊断与治疗指南(2021版)》发布,将CTEPH作为单独章节,从CTEPH早期识别、诊断及治疗三个方面出发,明确了如何利用影像学检查早期识别CTEPH,提出了肺动脉血栓内膜剥脱术、靶向药物治疗、球囊肺动脉成形术的适...     

慢性肺动脉栓塞的外科治疗

为探讨手术治疗慢性肺动脉栓塞的疗效,对9例临床诊断为慢性肺动脉栓塞患者在全麻及体外循环下行血栓清除及肺动脉内膜剥脱术。结果:9例患者术后恢复顺利,随访9～72个月,远期效果良好。认为对慢性肺动脉栓塞患者采用外科血栓清除及肺动脉内膜剥脱术是行之有效的治疗方法。     

体外循环下手术治疗慢性肺动脉血栓栓塞的临床研究

目的探讨体外循环下慢性肺动脉血栓栓塞的手术治疗方法及围手术期的处理,以提高慢性肺动脉血栓栓塞的外科治疗水平。方法回顾性分析2006年1月至今9例慢性肺动脉血栓栓塞的患者,在低温停循环或间断深低温停循环下行肺动脉血栓取出及内膜剥脱术。结果全组9例无一例近期(3个月)死亡,术后患者临床症状均较术前明显减轻、活动能力明显提高、部分病例心功能完全恢复正常。结论体外循环下肺动脉血栓取出术和内膜剥脱术是慢性肺动脉血栓栓塞的有效治疗方法。     

慢性血栓栓塞性肺动脉高压的靶向药物治疗

慢性血栓栓塞性肺动脉高压（CTEPH）是一种可能被治愈的肺动脉高压,部分患者可通过肺动脉血栓内膜剥脱术（PEA）达到治愈。但有半数以上的患者不适宜行该手术,或手术后仍有持续性或复发性肺动脉高压,对于这些患者,利奥西呱是惟一具有适应证的靶向药物。然而,慢性血栓栓塞性肺动脉高压与肺动脉高压（PAH）两者临床与病理表现有相似之处,临床上也有应用其他肺动脉高压靶向药物治疗慢性血栓栓塞性肺动脉高压的患者,并且部分药物随机对照试验（RCT）研究也显示其疗效和安全性,为患者提供了新的治疗策略。     

肺癌患者肺叶切除术后肺功能的变化

目的观察肺癌患者行单侧肺叶切除术的术前、术后肺功能及血气指标变化。方法测定63例行单侧肺叶切除术的肺癌患者术前、术后3个月的肺功能及血气指标。结果术后早期肺功能各项指标均有下降（P〈0．05）。术后3个月FEV1及DLCO较术前有所改善,与术前相比,P〈0．05。结论单侧肺叶切除术对肺癌患者肺功能无显著影响,其气道阻塞程度及弥散功能术后有所改善。     

Nonneoplastic diseases of aorta and pulmonary trunk—Part V

This five-part review focuses on selected nonneoplastic diseases of the aorta and pulmonary trunk. Because many more diseases affect the aorta compared with the pulmonary trunk and the right and left main pulmonary arteries, most of this review will be devoted to disorders of the aorta. Part V of this five-part series on diseases of the aorta and the pulmonary trunk focuses on nonneoplastic diseases of the pulmonary trunk and the right and left main pulmonary arteries.     

Chronic solitary pulmonary nodule due to unsuspected pulmonary infarction from silent pulmonary embolism

Abstract A case of pulmonary embolism showing a longstanding solitary pulmonary nodule is presented. An asymptomatic 57 year-old man with a solitary nodule in the right lower lobe was referred to our hospital. A pulmonary perfusion-ventilation scan following a sudden onset of dyspnoea established the diagnosis of recurrent pulmonary embolism. The nodule gradually disappeared after anticoagulant treatment, indicating that the nodule was pulmonary infarction from silent pulmonary embolism. Although the incidence of pulmonary infarction is low in Japan, this case suggests that pulmonary infarction from silent pulmonary embolism should be considered as one important cause of a solitary pulmonary nodule.     

15例老年人肺动脉栓塞临床病理分析

目的分析尸检中６５岁以上老年人肺动脉栓塞（以下简称肺栓塞）的临床、病理资料，探讨老年人肺栓塞的特点及误诊原因。方法收集我院１９５１～１９９２年尸检１１１１例中老年人肺栓塞１５例，对照分析其临床、病理特点。结果男性１４例，女性１例，年龄６５～８２岁。误诊率８６．７％。原有基础病以冠心病、慢性阻塞性肺疾病（ＣＯＰＤ）、糖尿病为多。结论老年人肺栓塞病情重且复杂、临床表现不典型、各种疾病表现相互掩盖可能是误诊的主要原因     

Treatment options and strategies for acute severe pulmonary embolism

Pulmonary thromboembolism (PE) is the third most frequent cause of cardiovascular death after ischaemic heart disease and stroke. In fatal PE, 2/3 of patients die within first hour of presentation. There is a clinical impetus to rapidly recognize, risk-stratify and appropriately treat patients with acute severe PE. Current recommendations present conflicting classification systems, and there is often some confusion in the clinical evaluation and management of patients with acute severe PE. This review presents a series of real clinical cases, which illustrate the available treatment options, ranging from conservative therapy to thrombolysis through to percutaneous catheter fragmentation and open surgical embolectomy. We evaluate the evidence for the various strategies and propose an algorithm for clinicians with a focus on early risk stratification and timely referral. This is particularly relevant to regional and remote centres, as well as secondary and tertiary institutions.     

The pulmonary circulation and its systemic arterial supply in pulmonary atresia

The pulmonary circulation and its systemic arterial supply in cases of pulmonary atresia were studied angiocardiographically. In 69% of the cases the pulmonary arteries were hypoplastic and supplied by a patent ductus arteriosus or a few large systemic arteries. A classification into four groups is suggested, and a developmental paradox represented by this classification is discussed.     

Primary pulmonary hypertension in adults

Primary pulmonary hypertension is an enigmatic disease found predominantly in young women, but it also affects a significant number of middle-aged and elderly males and females. Its onset, characterized by progressively worsening dyspnea, fatigue, and chest pain, is insidious. Three distinct histopathologic subtypes have been identified, and the natural history of the disease process has been well-defined. Pharmacologic treatment options have, in general, been disappointing, and it appears that heart-lung transplantation will be applied only to a small minority of young patients with primary pulmonary hypertension in the near future. We review the histopathology, evaluation, treatment, and prognosis of primary pulmonary hypertension.